Gait analysis in multiple sclerosis: characterization of temporal-spatial parameters using GAITRite functional ambulation system.
BACKGROUND
Gait impairment is a significant problem in multiple sclerosis (MS), leading to decreased activity and limitations in function. However, specific characterization of abnormal gait in MS patients has only been described in small groups of patients, mainly using observational tools.


OBJECTIVE
The aim of the current study was to characterize the spatio-temporal gait parameters in MS patients and ascribe them to clinical variables, in order to enable target-oriented management.


METHODS
Eighty-one MS patients with relatively short disease duration (5.3; S.E.=0.3) able of independent walking and 25 age-matched healthy subjects were evaluated using the GAITRite Functional Ambulation System. Subjects also underwent a thorough neurological examination to assess their disability using the Expanded Disability Status Scale (EDSS). Gait parameters were compared between patients and able-bodied controls to characterize the gait impairments in MS. Within the group of patients the correlation of gait parameters with clinical neurological variables was investigated.


RESULTS
MS patients demonstrated significant impairments in all spatio-temporal gait parameters compared to able-bodied healthy subjects. MS patients had a mean Functional Ambulation Profile (FAP) score of 83.0 and a mean velocity of 85.5m/s while the controls had a FAP score of 95.0 (p<0.001) and a velocity of 138.6m/s (p<0.001). Cadence was 94.4 steps/min in MS patients and 115.2 in controls (p<0.001). Step length was 45.3 cm in MS patients and 72.1 cm in controls (p<0.001). FAP score negatively correlated with disease duration (p<0.001) and EDSS (p<0.001). The most significant correlations of the FAP were found with the pyramidal (p<0.002), and the cerebellar (p<0.05) functional scores. Specifically, gait velocity, single support time and swing time negatively correlated with the pyramidal functional score, while double support time positively correlated with the pyramidal score. The base support width positively correlated with cerebellar functional score.


CONCLUSIONS
Gait parameters were impaired in MS, even in patients with relatively short disease duration. The impaired gait patterns correlated with the associated neurological disability. Specific and accurate assessment of gait can be a useful tool to monitor MS evolution and can be used to advise target-oriented rehabilitative management of MS patients.
Givon
Uri
U
Department of Pediatric Orthopaedics, Safra Hospital for Children and Motion Analysis Laboratory, Sheba Medical Center, Tel-Hashomer, Israel. ugivon@zahav.net.il
Zeilig
Gabriel
G
Achiron
Anat
A
D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008124:Locomotion / Q000502:physiology; D008297:Male; D009103:Multiple Sclerosis / Q000503:physiopathology*; D012044:Regression Analysis; D012680:Sensitivity and Specificity